That’s the highest number of “A” grades earned by New Jersey hospitals in any of the five report cards released since the first one in 2012. New Jersey ranked seventh among the states in the number of “A” grades.

Hospital executives are changing policies in response to both the public attention given to the reports and financial incentives tied to the scores, according to health advocates and representatives of the Leapfrog Group, a Washington, DC, nonprofit founded by employers and focused on increasing hospital safety, quality and affordability.

The scores are are based on 28 measures, which range from whether hospitals have intensive-care specialists in their ICUs to how many patients acquire pressure ulcers during their hospital stays.

“What we hear anecdotally is that hospitals across the country are working quite hard to try to improve their grades,” said Leah Binder, Leapfrog Group president and CEO.

This is particularly true in states like New Jersey, where the grades are rising. Hospitals have been touting their positive grades -- in part because insurers are weighing hospital safety in making payments to hospitals.

The two hospitals that saw the biggest change in their grades since the fall are both in Monmouth County: Jersey Shore University Medical Center in Neptune and Riverview Medical Center in Red Bank, which both raised their grades to “A” from “C.”

Both hospitals chalked up broad-based improvements, including increasing the coverage of their ICUs by specialists and implementing recommended practices for washing hands.

No New Jersey hospitals were among the 22 hospitals in the country with failing grades.

Saint Michael’s Medical Center in Newark was the only hospital in the state to receive a “D.” Officials there rejected the significance of the report, with hospital spokeswoman Cathy Toscano saying that it relies on “limited, dated information and does not reflect quality improvements we have made and continue to make.”

Toscano said the hospital has implemented electronic medical records, quality action committees to review workflow and documentation processes, and an infection-prevention team. She added that various ratings systems can be useful to patients, but that they shouldn’t rely on any one of them.

But Binder said safety should be the primary consideration when patients choose a hospital.

“The first thing you want to know when you step foot into a hospital is whether it’s safe,” Binder said, noting that other factors like whether the hospital is strong in the services a patient needs should be considered.

Binder added that the scores are a work in progress.

“There’s a good number of measures that we just don’t have access to,” including details about hospital-acquired infections and medication errors, she said.

She also noted that hospital accreditation reports are used by the federal Centers for Medicare & Medicaid Services, which are “owned by the taxpayers,” but details from the reports aren’t publicly available.

“There’s a good number of hospitals that would like to see all this public reporting go away but I have some bad news for them – this is a free country” and residents have a right to know how hospitals are doing, Binder said. “Americans are unwilling to go back to the time when hospitals kept everything private.”

She expressed certainty that “our children will have much more information available about hospitals than we do now and hopefully our grandchildren will have even more.”

This is particularly important as more people are enrolled in health plans in which they have to pay more out-of-pocket expenses and want to know “how much is it going to cost me and how much am I getting for my money,” said Binder, adding that instituting safety checklists and “hand hygiene” campaigns isn’t costly but can make a big difference in safety.

Of the 66 New Jersey hospitals, 13 improved their scores, while eight dropped by a letter grade. The grades of the other 45 hospitals were unchanged.

Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute, praised the improvements made by New Jersey hospitals. She noted that Horizon Blue Cross Blue Shield of New Jersey is using Leapfrog scores in calculating their bonus payments for hospital quality improvements.

Hospitals “always cared about quality but that makes it even more of an incentive,” she said.

Schwimmer said institute officials would like to see every hospital in the state receive an A, which she said is possible without lowering the grading standards.

As the hospitals continue to consolidate and insurers offer plans with fewer hospitals, “it’s more important for consumers to know the safety of the hospitals available to them,” Schwimmer said, noting that the scores can be searched quickly by ZIP code through a mobile application.